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Guariglia v. Local 464A United Food

United States District Court, D. New Jersey

May 16, 2018

KRISTINE GUARIGLIA, Plaintiff,
v.
LOCAL 464A UNITED FOOD AND COMMERCIAL WORKERS UNION WELFARE SERVICE BENEFIT FUND, Defendant.

          OPINION

          SUSAN D. WIGENTON, U.S.D.J.

         Before the Court is defendant Local 464A United Food and Commercial Workers Union Welfare Service Benefit Fund's (“Defendant”) Motion to Dismiss and plaintiff Kristine Guariglia's (“Plaintiff”) Cross Motion for Partial Summary Judgment. Jurisdiction is proper pursuant to 28 U.S.C. § 1132(e)(1). Venue is proper pursuant to 28 U.S.C. § 1132(e)(2). This opinion is issued without oral argument pursuant to Federal Rule of Civil Procedure 78. For the reasons set forth below, Defendant's Motion to Dismiss is GRANTED and Plaintiff's Cross Motion is DENIED.

         I. BACKGROUND AND PROCEDURAL HISTORY

         On April 4, 2012, Plaintiff was a participant in a health plan (the “Plan”) administered by Defendant, when Plaintiff tripped and was injured due to a pothole in a public roadway. (Compl. ¶¶ 4-5.) As a result, Plaintiff incurred medical expenses and may continue to incur expenses in the future due to the injuries she sustained. (Id.) The Plan is governed by the Employee Retirement Income and Security Act, 29 U.S.C. § 1001 et seq., (“ERISA”). (Id. ¶ 1.)

         On November 13, 2012, Plaintiff filed a lawsuit in the Superior Court of New Jersey against James R. Ientile, Inc., Esposito Construction, the Borough of Matawan, Borough of Matawan Sewerage Authority, XYZ Corp., and John Does 1-10 for personal injuries arising from her accident (“Liability Action”). (Id. ¶ 6.) Plaintiff also filed a claim against the Plan for payment of medical expenses incurred in connection with the injuries that she sustained. (Id. ¶ 7.) The Plan advised Plaintiff that before it would cover her medical costs, it required her to execute an Agreement to Reimburse and for Equitable Lien (the “Agreement”) “by which plaintiff would have agreed to reimburse the Plan out of any recovery” that she could realize as a result of the Liability Action. (Id. ¶¶ 8-9.) Plaintiff declined to sign the Agreement. (Id. ¶ 9.)

         On February 25, 2013, Plaintiff filed suit in this Court, attempting to “compel the Plan to pay her medical expenses notwithstanding her refusal to sign the Agreement.” (Id. ¶ 10; see also Guariglia v. Local 464A United Food & Commercial Workers Union Welfare Serv. Benefit Fund, Civ. No. 13-1110, 2013 WL 6188510 (D.N.J. Nov. 25, 2013) (“Guariglia I”). Shortly thereafter, Defendant moved to dismiss and Plaintiff filed a cross motion for summary judgment. Guariglia I, 2013 WL 6188510 at *2. This Court granted Defendant's motion on November 25, 2013, finding that the Plan “does not cover healthcare expenses for which a third party is responsible to pay” and that its terms permitted it to condition “payment of medical expenses upon a Reimbursement Agreement.” Id. at *5. This Court further denied Plaintiff's cross motion, rejecting Plaintiff's argument “that the Plan is required to pay Plaintiff's medical expenses as a primary payor and that it had no valid equitable claim against her recovery from” the Liability Action. Id. at *7.

         Nearly four years later, the Liability Action went to trial and the jury verdict finding no cause of action was memorialized in an Order for Judgment entered in the state court on May 22, 2017. (Compl. ¶ 12.) On January 2, 2018, Plaintiff filed the instant suit in this Court, again seeking to force Defendant to “pay medical expenses associated with her [L]iability [A]ction.” (Id. ¶ 17.) Defendant moved to dismiss Plaintiff's Complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). (Dkt. No. 4.) Plaintiff opposed the motion and filed a cross motion for partial summary judgment pursuant to Federal Rule of Civil Procedure 56. (Dkt. No. 5.)

         II. LEGAL STANDARD

         Motion to Dismiss

         An adequate complaint must be “a short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). This Rule “requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a right to relief above the speculative level[.]” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007) (internal citations omitted); see also Phillips v. Cty. of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008) (stating that Rule 8 “requires a ‘showing, ' rather than a blanket assertion, of an entitlement to relief”).

         In considering a Motion to Dismiss under Rule 12(b)(6), the Court must “accept all factual allegations as true, construe the complaint in the light most favorable to the plaintiff, and determine whether, under any reasonable reading of the complaint, the plaintiff may be entitled to relief.” Phillips, 515 F.3d at 231 (external citation omitted). However, “the tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions. Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); see also Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir. 2009) (discussing the Iqbal standard). Determining whether the allegations in a complaint are “plausible” is “a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679. If the “well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, ” the complaint should be dismissed for failing to “show[] that the pleader is entitled to relief” as required by Rule 8(a)(2). Id.

         Motion for Summary Judgment

         Summary judgment is appropriate “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). The “mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). A fact is only “material” for purposes of a summary judgment motion if a dispute over that fact “might affect the outcome of the suit under the governing law.” Id. at 248. A dispute about a material fact is “genuine” if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id. The dispute is not genuine if it merely involves “some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986).

         The moving party must show that if the evidentiary material of record were reduced to admissible evidence in court, it would be insufficient to permit the nonmoving party to carry its burden of proof. Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). Once the moving party meets its initial burden, the burden then shifts to the nonmovant who must set forth specific facts showing a genuine issue for trial and may not rest upon the mere allegations, speculations, unsupported assertions or denials of its pleadings. Shields v. Zuccarini, 254 F.3d 476, 481 (3d Cir. 2001). “In considering a motion for summary judgment, a district court may not make credibility determinations or engage in any weighing of the evidence; instead, the non-moving party's ...


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